Nutrition education curricula and print, audiovisual, and
computer-based materials are available from government agencies,
voluntary organizations, corporations, and commodity organizations.
State Nutrition Education and Training Program coordinators can
help schools identify the most appropriate nutrition education
curricula and materials. National clearinghouses that can help
schools identify a wide range of nutrition education and school
food service resources are sponsored by the U.S. Department of
Agriculture's Food and Nutrition Information Center and the
National Food Service Management Institute; the former also serves
as a lending library.

At the local and state levels, educational materials or
curricula may be available from affiliates of voluntary health
promotion organizations (e.g., the American Cancer Society or the
American Heart Association), commodity organizations or national
boards for specific food industries, county cooperative extension
services, local and state health departments, school districts,
state education agencies, and universities. At the national level,
nutrition education materials can also be obtained from the
following voluntary organizations and federal government agencies:

In 1990, CDC established the Youth Risk Behavior Surveillance
System to help monitor progress in attaining national health and
education objectives by periodically measuring the prevalence of
behaviors in six health risk categories. These behaviors, which are
usually established during youth, contribute to the leading causes
of death and disease in the United States. Dietary behaviors are
one of the six health risk categories. CDC conducts the Youth Risk
Behavior Survey (YRBS) biennially in a national probability sample
of high school students and enables interested state and local
education agencies to conduct the survey in comparable probability
samples in states and cities (127). The specific dietary behaviors
and attitudes monitored by the YRBS include consumption of fruits
and vegetables, consumption of foods high in fat, perceptions of
body weight, and attempted weight loss and weight-loss techniques
used. The YRBS also obtains information about specific physical
activity behaviors.

In 1994, CDC conducted the School Health Policies and Programs
Study (SHPPS), which is a national study of school policies and
programs at the school, district, and state levels that support
comprehensive school health programs. The study also provides
baseline data on national health and education objectives that can
be attained through school health and physical education, school
food service, and school health services and policies (229).

SHPPS included a mail survey of local and state education
agencies' policies related to school health in grades kindergarten
through 12. The survey was conducted in all states and in a
nationally representative sample of districts. The study also
included on-site, structured interviews with school principals,
health education teachers, physical education teachers, school food
service directors, school nurses, counselors, and other personnel
in a nationally representative sample of middle schools and high
schools. The questionnaire included the following: school nutrition
education requirements for students; the content of nutrition
education curricula; training and joint activities of food service
staff and teachers responsible for nutrition education; school
policies related to foods sold in vending machines and for
fundraising; food service practices related to purchasing and
preparing food; involvement of parents, staff, and students in
planning food service meals; and involvement of fast-food or food
service management companies in school meals.

Single copies of YRBS and SHPPS reports are available from
CDC's Division of Adolescent and School Health, National Center for
Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, Mailstop K-33, 4770 Buford Highway,
NE, Atlanta, GA 30341-3724; telephone: (770) 488-5330.

Different, developmentally appropriate activities are listed
for lower elementary school, upper elementary school, and middle
and high school students (194). This list is not intended to be
comprehensive. However, it does include many of the concepts
critical to improving the diet and health of young persons in this
country. Schools should review these educational activities in
relation to their students' needs and abilities to determine which
activities are appropriate at each grade level.

Interventions that promote healthy changes in eating behaviors
need to target three interacting spheres of influence: (a) the
environment, which influences the likelihood that healthy eating
behaviors will be adopted through social norms, influential role
models, cues to action, reinforcements, and opportunities for
action; (b) personal characteristics (e.g., knowledge, attitudes,
beliefs, values, confidence in one's ability to change eating
behaviors, and expectations about the consequences of making those
changes); and (c) behavioral skills and experience, which are
related to selecting or preparing specific foods, dietary
self-assessment, and decision-making (186, 194,203,204).

The strategies listed here require the involvement of
teachers, administrators, food service personnel, other school
staff, and parents (194). Classroom teachers play the lead role in
most of these activities, but many activities would be most
effective if they were reinforced by other persons; all adults in
the school community can help by serving as role models. Each
school or district should determine the policies it needs to guide
its nutrition-related activities and who is responsible for the
tasks.

For lower elementary students

Strategies to make the food environment more health-enhancing

Make healthy foods (e.g., fruits, vegetables, and whole grains)
widely available at school, and discourage the availability of
foods high in fat, sodium, and added sugars.

Through class discussions and small-group exercises, provide
social support for making healthy changes in eating and physical
activity.

Provide cues, through posters and marketing-style incentives that
students design, that encourage students to make healthy choices
about eating and physical activity.

Use incentives, such as verbal praise or token gifts, to
reinforce healthy eating and physical activity. Do not use food
as
a reward or punishment of any behavior.

Strategies to enhance personal characteristics that will support
healthy eating

Explain the effects that diet and physical activity have on
future health as well as on immediate concerns (e.g., current
health, physical appearance, obesity, sense of well-being, and
capacity for physical activity).

Teach the principles of the Dietary Guidelines for Americans and
the Food Guide Pyramid. Instill pride in choosing to eat meals
and
snacks that comply with these principles.

Help students identify foods high and low in fat, saturated fat,
cholesterol, sodium, added sugars, and fiber.

Teach the importance of balancing food intake and physical
activity.

Teach the importance of eating adequate amounts of fruits,
vegetables, and whole grains.

Help students increase the value they place on health and their
sense of control over food selection and preparation.

Increase students' confidence in their ability to make healthy
eating choices by gradually building up their food selection and
preparation skills and giving them practice.

Have students analyze food preferences and factors that trigger
eating behaviors.

Strategies to enhance behavioral capabilities that will support
healthy eating

Provide opportunities for students to taste many healthy foods in
an enjoyable social context.

Let students prepare healthy snacks or simple meals.

Encourage students to try unfamiliar and culturally diverse foods
that are low in fat, sodium, and added sugars and that are high
in
fiber.

Have students select healthy foods from a fast-food restaurant
menu.

Teach students how to recognize the fat, sodium, and fiber
contents of foods by reading nutrition labels.

Help students record and assess their food intake.

Teach students how to use the Food Guide Pyramid to assess their
diet for variety, moderation, and proportionality.

Have students set simple goals for changes in eating and physical
activity, and devise strategies for implementing these changes
and
monitoring progress in reaching their goals.

When appropriate, let students practice (through role plays)
encouraging parents to make healthy choices about eating and
physical activity at home.

Have students examine media and social influences on eating and
physical activity; teach students how to respond to these
pressures.

For middle and high school students

Strategies to make the food environment more health-enhancing

Make healthy foods (e.g., fruits, vegetables, and whole grains)
widely available at school, and discourage the availability of
foods high in fat, sodium, and added sugars.

Provide role models (e.g., teachers, parents, other adults, and
celebrities) for healthy eating.

Use peers as role models, and use peer-led nutrition education
activities.

Through class discussions and small-group exercises, provide
social support for making healthy changes in eating and physical
activity.

Provide cues, through posters and marketing-style incentives that
students design, that encourage students to make healthy choices
about eating and physical activity.

Strategies to enhance personal characteristics that will support
healthy eating

Explain the effects that diet and physical activity have on
future health as well as on immediate concerns (e.g., current
health, physical appearance, obesity, eating disorders, sense of
well-being, and capacity for physical activity).

Have students identify reasons to adopt healthy eating and
physical activity patterns.

Teach the principles of the Dietary Guidelines for Americans.
Instill in the students pride in choosing to eat meals and snacks
that comply with these principles.

Teach students how to identify foods high and low in fat,
saturated fat, cholesterol, sodium, and added sugars.

Teach students how to identify foods that are excellent sources
of fiber, complex carbohydrates, calcium, iron, vitamin A,
vitamin
C, and folate.

Teach the importance of balancing food intake and physical
activity.

Teach the effects of unsafe weight-loss methods and the
characteristics of a safe weight-loss program.

Help students increase the value they place on health and their
sense of control over food selection and preparation.

Increase students' confidence in their ability to eat healthily
by gradually building up their skills and giving them practice.

Help students examine what motivates persons to adopt particular
eating habits. Have students keep a food diary noting what cues
their own eating behavior (e.g., mood, hunger, stress, or other
persons).

Strategies to enhance behavioral capabilities that will support
healthy eating

Let students plan and prepare healthy meals.

Have students select healthy foods from restaurant and cafeteria
menus.

Teach students how to use nutrition labels to make healthy food
choices.

Teach students ways to modify recipes and prepare foods to reduce
fat and sodium content and to increase fiber content.

Help students identify incentives and reinforcements for their
current eating and physical activity behaviors.

Have students examine media and social inducements to adopt
unhealthy eating and physical activity patterns, teach them how
to
respond to these pressures, and let them use their new knowledge
to
identify their own resistance strategies.

Have students analyze environmental barriers to healthy eating
and physical activity; explore strategies for overcoming these
barriers.

When appropriate, give students practice in encouraging parents
to make healthy choices about eating and physical activity at
home.

Teach students to record their food intake, then have them assess
and compare their diets with the standards set forth in the
Dietary
Guidelines for Americans and the Food Guide Pyramid. Have them
assess and compare their intake of key nutrients (e.g., calcium
and
iron) with the intake recommended by the Public Health Service.

Have students set goals for healthy changes in eating and
physical activity, identify barriers and incentives, and assess
alternative strategies for reaching their goals and decide which
to
follow. Show students how to monitor their progress, revise their
goals if necessary, and reward themselves for successfully
attaining their goals.

Teach students how to evaluate nutrition claims from
advertisements and nutrition-related news stories.

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